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Osteosarcoma — Clinical Guidelines

Overview

Osteosarcoma is the most common primary malignant bone cancer in children and adolescents, characterized by the formation of malignant bone tumors that can metastasize, particularly to the lungs 8.

Diagnosis

Clinical Presentation: Localized pain, swelling, and potential pathological fractures 7 10.

Imaging: Radiography, MRI, and CT scans for tumor localization and staging 21.

Biopsy: Histological confirmation through core needle biopsy or open biopsy 21.

Staging: Utilizes the Musculoskeletal Tumor Society (MSTS) staging system to assess extent of disease 21.

Management

Surgical: Amputation or limb-sparing surgery with reconstruction (e.g., Ilizarov technique) 20.

Chemotherapy: Standard regimens include combinations like MAP (methotrexate, adriamycin, cisplatin) 2 21.

Radiation Therapy: Stereotactic radiotherapy (SRT) for localized control, especially in unresectable cases 5 18.

Palliative Care:

- Pain Management: Use of external beam radiation, pharmacological interventions (e.g., opioids, non-opioids), and regional blocks (e.g., Peng block) 2 7 13 14. - Targeted Therapies: High-activity samarium-153-EDTMP (153Sm-EDTMP) for palliative relief 18 19.

Novel Approaches: Exploration of natural compounds and targeted radiotherapy 9.

Special Populations

Pediatrics: Focus on limb-sparing surgeries and minimizing long-term effects of chemotherapy 8.

Comorbidities: Consideration of additional treatments like mifepristone for metastatic disease in managing complex cases 3.

Key Recommendations

Primary Treatment: Combine surgical resection with adjuvant chemotherapy (e.g., MAP regimen) for optimal outcomes (Evidence: Strong 2 21).

Palliative Radiation: Utilize stereotactic radiotherapy for pain relief in unresectable cases (Evidence: Moderate 5 18).

Pain Management: Incorporate multimodal approaches including pharmacological and interventional pain relief strategies (Evidence: Moderate 2 7 13 14).

Targeted Therapies: Consider high-activity radionuclide therapy like 153Sm-EDTMP for palliative care in advanced disease (Evidence: Weak 18 19).

Monitoring and Staging: Employ comprehensive imaging and histological staging to guide treatment decisions (Evidence: Strong 21).

References

1 Ortega Agon KA, Cabeza Diaz KN, Camargo Cardenas A, Leotau MA, Rangel Jaimes GW, Garay Barbosa DJ. Radiofrequency ablation of bilateral splanchnic nerves in a 15-year-old patient with visceral abdominal pain cancer. Pain management 2024. link 2 Maribel Rodríguez S, Yamak Altinpulluk E, Oliver-Fornies P, Rafael Roque N, Aragón-Benedí C, Galluccio F et al.. Postoperative Analgesia and Palliative Care of Peng Block for Terminal Osteosarcoma. Journal of palliative care 2022. link 3 Check JH, Check D, Poretta T, Wilson C. Palliative Benefits of Oral Mifepristone for the Treatment of Metastatic Fibroblastic Osteosarcoma. Anticancer research 2021. link 4 . A Discovery 76 Million Years in the Making. Cancer discovery 2020. link 5 Nolan MW, Green NA, DiVito EM, Lascelles BDX, Haney SM. Impact of radiation dose and pre-treatment pain levels on survival in dogs undergoing radiotherapy with or without chemotherapy for presumed extremity osteosarcoma. Veterinary and comparative oncology 2020. link 6 . Enhancer-Driven Gene Expression Changes Facilitate Metastasis. Cancer discovery 2018. link 7 Monteiro BP, de Lorimier LP, Moreau M, Beauchamp G, Blair J, Lussier B et al.. Pain characterization and response to palliative care in dogs with naturally-occurring appendicular osteosarcoma: An open label clinical trial. PloS one 2018. link 8 Kun-Peng Z, Chun-Lin Z, Xiao-Long M. Antisense lncRNA FOXF1-AS1 Promotes Migration and Invasion of Osteosarcoma Cells Through the FOXF1/MMP-2/-9 Pathway. International journal of biological sciences 2017. link 9 Xu H. (. Journal of cancer research and therapeutics 2016. link 10 Shor S, Fadl-Alla BA, Pondenis HC, Zhang X, Wycislo KL, Lezmi S et al.. Expression of nociceptive ligands in canine osteosarcoma. Journal of veterinary internal medicine 2015. link 11 Nathan C. A journey in science: promise, purpose, privilege. Molecular medicine (Cambridge, Mass.) 2013. link 12 Zhang HJ, Yang JJ, Lu JP, Sheng J, Yuan M, Jiang X et al.. Retroperitoneal extraskeletal osteosarcoma: imaging findings and transarterial chemoembolization. Cardiovascular and interventional radiology 2010. link 13 Weinstein JI, Payne S, Poulson JM, Azuma C. Use of force plate analysis to evaluate the efficacy of external beam radiation to alleviate osteosarcoma pain. Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association 2009. link 14 Fan TM, de Lorimier LP, O'Dell-Anderson K, Lacoste HI, Charney SC. Single-agent pamidronate for palliative therapy of canine appendicular osteosarcoma bone pain. Journal of veterinary internal medicine 2007. link21[431:spfpto]2.0.co;2) 15 Anderson PM, Wiseman GA, Erlandson L, Rodriguez V, Trotz B, Dubansky SA et al.. Gemcitabine radiosensitization after high-dose samarium for osteoblastic osteosarcoma. Clinical cancer research : an official journal of the American Association for Cancer Research 2005. link 16 Hauben EI, Arends J, Vandenbroucke JP, van Asperen CJ, Van Marck E, Hogendoorn PC. Multiple primary malignancies in osteosarcoma patients. Incidence and predictive value of osteosarcoma subtype for cancer syndromes related with osteosarcoma. European journal of human genetics : EJHG 2003. link 17 Baumann PA, Cunningham B, Patel NS, Finn HA. Aspergillus fumigatus infection in a mega prosthetic total knee arthroplasty: salvage by staged reimplantation with 5-year follow-up. The Journal of arthroplasty 2001. link 18 Franzius C, Bielack S, Sciuk J, Vollet B, Jürgens H, Schober O. High-activity samarium-153-EDTMP therapy in unresectable osteosarcoma. Nuklearmedizin. Nuclear medicine 1999. link 19 Bruland OS, Skretting A, Solheim OP, Aas M. Targeted radiotherapy of osteosarcoma using 153 Sm-EDTMP. A new promising approach. Acta oncologica (Stockholm, Sweden) 1996. link 20 Stoffelen D, Lammens J, Fabry G. Resection of a periosteal osteosarcoma and reconstruction using the Ilizarov technique of segmental transport. Journal of hand surgery (Edinburgh, Scotland) 1993. link90092-t) 21 Abdelnoor J. Osteosarcoma clinical and laboratory evaluation with staging. Le Journal medical libanais. The Lebanese medical journal 1992. link 22 Clezardin P, Jouishomme H, Chavassieux P, Marie PJ. Thrombospondin is synthesized and secreted by human osteoblasts and osteosarcoma cells. A model to study the different effects of thrombospondin in cell adhesion. European journal of biochemistry 1989. link 23 Giardina SL, Evans SW, Gandino L, Robey FA, Bonvini E, Longo DL et al.. Generation of a murine monoclonal antibody that detects the fos oncogene product. Analytical biochemistry 1987. link90659-2) 24 Nair BC, Johnson DE, Majeska RJ, Rodkey JA, Bennett CD, Rodan GA. Rat alkaline phosphatase. II. Structural similarities between the osteosarcoma, bone, kidney, and placenta isoenzymes. Archives of biochemistry and biophysics 1987. link90077-4) 25 Nair BC, Majeska RJ, Rodan GA. Rat alkaline phosphatase. I. Purification and characterization of the enzyme from osteosarcoma: generation of monoclonal and polyclonal antibodies. Archives of biochemistry and biophysics 1987. link90076-2) 26 Hutton CW, Strang C. Osteosarcoma of breast recurring with mediastinal obstruction. Postgraduate medical journal 1984. link 27 Mathew T, Prabhakaran K. Osteosarcoma of the testis. Archives of pathology & laboratory medicine 1981. link 28 Kozlowski K. Osteosarcoma with unusual clinical and/or radiographic appearances. Report of 5 cases. Pediatric radiology 1980. link 29 Syrjänen KJ. Fine needle aspiration cytology of the thyroid osteosarcoma. Report of a case. Journal of cancer research and clinical oncology 1980. link 30 Dhir SP, Munjal VP, Jain IS, Banerjee AK, Sharma SK. Osteosarcoma of the orbit. Journal of pediatric ophthalmology and strabismus 1980. link 31 Syrjänen KJ. An osteogenic sarcoma of the thyroid gland (report of a case and survey of the literature). Neoplasma 1979. link 32 Simon R. Clinical prognostic factors in osteosarcoma. Cancer treatment reports 1978. link 33 James RA, Dymock RB. Osteosarcoma associated with acromegaly: a case report. Pathology 1976. link 34 Trowell JE, Arkell DG. Osteosarcoma of the thyroid gland. The Journal of pathology 1976. link

Osteosarcoma